New billing codes for US-guided joint injections for 2015: 20604, 20606, 20611 for small, medium and large joints respectively. Average reimbursement: $72, $80, $91. The previous joint injection codes will now specify no US guidance. Bundling sucks.
No. This does not include fluoro.Does this include fluoro also?
In Colorado:how much do the previous codes for small, med, large joints pay? (no US)
These new codes are for joint injections only, which means you can still bill 76942 with everything else. Funny how doing a thoracic trigger point injection with US guidance to prevent pneumothorax will now pay $44 more than a large joint injection.thanks for the information, I should look it up myself but haven't yet.
do you know what US guidance for other procedures is? is 76942 still around for tap or nerve block, tendonopathies, etc
I think with this trend the only way for use of US to remain financially viable is to purchase the cheapest US machines available. A friend of mine just purchased this one:Boy, I'm so glad I leased a new machine. Between the cost of supplies and lease I probably make $1. I'd make more money doing an oil change.
What are you talking about? 77002 goes down.Why is Us bundled but Fluoro isn't? That would be unusual. If so Fluoro guided joint injections are actually getting an increase.
90+63 vs last year 61+80
That is actually good news so there must be a catch.
I don't see the actual 77002 reimbursement. I don't believe 7002-TC and 77002-26 are for joint injectionsASSIP link still shows
20610 $60 for 2015
77002 $64 for 2015
I didn't see the new code you reported
20611 $91 for 2015
Are we able to bill 20611 and 77002? If so then more $$
I think I misunderstood your post and it is specific for us. In that case can still use 20610 with 77002 which is a cut but better than US.
I appreciate the heads up on the coding just trying to figure out the specifics.
Boy, I'm so glad I leased a new machine. Between the cost of supplies and lease I probably make $1. I'd make more money doing an oil change.
???Interpret your findings that was to US-how much does adding a limited extremity US pay? If you want I'll interpret them for you for a few bucks.
Freddy is a radiologist in a pain fellowship.
BTW, can anybody answer how much a diagnostic MSK ultrasound pays, that is performed in office?
My guess is very close to the current value of the guidance code, but I have no concrete data.
US examination codes were divided into 2 separate codes a few years back, 76881 for a complete exam, and 76882 for a limited exam. (Some say this was in response to every podiatrist and his brother taking a 10 second look at every patients' heel and diagnosing plantar fasciitis, then billing out a fortune.) In any case, 76881 pays $120, and 76882 pays $36. 76881 will pay $3 less in 2015, at $117. I'm not sure how much less 76882 will pay, but can't imagine it will be more than a few dollars less, assuming it doesn't stay the same. To bill 76881 though, you really have to do a complete exam with full documentation. You can't just write, "No supraspinatus tear." My shoulder exam reports are a page and half long, commenting on every aspect including dynamic tests for impingement and AC joint separation. For the limited exam, your reports can be much more basic. Mine are usually a paragraph or 2 long. For example, a recent one went something like this: "There was significant soft tissue swelling seen in the adductor musculature. A hyperechoic region within the adductor musculature septa was noted, with the greatest amount of soft tissue swelling surrounding this area. The hyperechoic region also displayed the most sensitivity to palpation. This area is highly suspicious for early heterotopic ossification and triple phase bone scan is recommended. No obvious muscle tears or masses noted."
More like 25-30% of what it used to pay for guidance.Just glad I didn't buy an US machine last year. Use to pay over $200, now pays 1/10th of that. It would be a waste of time to even dust one off an use.
Brilliant!! I can include a family ultrasound portrait and perhaps ultrasound Christmas cards.Fetal photos.
Anyone have any brilliant ideas for making some decent money with the U.S.? I've got another 4 1/2 years on this lease and need to make the best of it. I had a paid off Sonosite and got into a new lease - bummer
I think with this trend the only way for use of US to remain financially viable is to purchase the cheapest US machines available. A friend of mine just purchased this one:
http://www.ebay.com/itm/Promotion-N...ty-/221442113363?ssPageName=ADME:L:OC:US:3160
Assuming you add a 3.5 MHz convex probe, it should still come out to around $2,000. There is another Chinese company on ebay making similar knock-offs with prices below 2k. Can't vouch for the quality or sturdiness of these units, but I think the days of spending anything over 15k for an US are over.
Not sure where you got your info from, but the new codes seem to be bundled for ALL joint injections, as listed in my original post.The new code is bundled only for major joint. The new RVU is combined and are close to 2 and 2014 i think more closer to 2.8 so not as dramatic as suggested about at 1/10 th the cut.
Not sure where you got your info from, but the new codes seem to be bundled for ALL joint injections, as listed in my original post.
I agree. I used to think image guidance for simple joint injections wasn't helpful, until I tried a few. I use Fluoro only because I was about to buy US until the cuts came last year, and abandoned just in time. But I noticed that when I started doing seemingly easy joints with fluoro, it became obvious to me that there were times I thought I was in with landmark technique, yet I look up at the screen and I'm clearly not. With today's growing population obesity, I think image guidance is becoming more needed with previously simple injections. So they killed US guidance. Fluoro will be next, but you're right, it's a shame. Because people are going to abandon a better technique for one less accurate and the quality of care will decrease. I'm sure it's happening in all other specialties too. It a sign of the times.This is very sad.
Injection with ultrasound guidance takes a lot of practice, skill, and know-how. It may also add time to your injection. This should be considered.
In addition, it makes the injections safer (according to nerve block data) - and every study in pain and ortho journals that have looked at it have found that it - BY FAR - makes it more effective. Even in experienced hands, blind injections miss the spot a lot of the time.
To me, if you cut reimbursement, you are begging physicians to abondon the practice - which in essence will decrease the level of care. How could they not see this?
Policy should be made such that practice patterns improve care....very very sad, and poor decision by CMS.
And no one profited ridiculously and tried to justify it. Every time I read an epidurogram report.....
Routine use is a waste of time and effort. I like when BCBS said if BMI is 40+ then US OK for fat knees. That makes sense. Literature supports 87% success in superolateral approach blind. Good enough for steroids and probably for Visco. Even though AAOS says Visco doesn't work.
I wouldn't say that 87% success rate is good enough for a blind injection. 98-99% percent maybe.
Remember that the patients who fail knee injections are often getting TKA, which has an 85% success rate, and those that fail TKA, often end up getting revision surgery or are just left with permanent knee pain. $75 for image guidance is more than reasonable to pay for any knee or shoulder injection, when you consider the risks, relative success, and cost of the surgical alternative.
I had a similar experience to what was described by EMD above. Once I started using fluoro for knees and shoulders, I noticed that 15-20% of the time when I thought I was in, I wasn't.
I say image guidance of some kind should be required for all joint injections. That way, all the half-assed blind injections by the orthopods wouldn't count as failure of conservative care, and patients wouldn't get unnecessary surgery.
Which is more expensive in the long run? It's not image guidance for joint injections.
Sounds nice and all. But not in merica. Politics and practice patterns go against this. Utopian. But never going to happen.
What about nerve blocks? Is US bundled?femoral, etcMaybe so, but as a pain physician, you shouldn't side with insurance companies trying to restrict coverage for guidance codes to only fat patients, as you stated in your last post.
You should never be in favor of reduced reimbursement. For anything. They've got enough help trying to tear us down without aiding the enemy.Sounds nice and all. But not in merica. Politics and practice patterns go against this. Utopian. But never going to happen.
I do not believe nerve blocks have been bundled. I also use US for thoracic TPI's to avoid pneumothorax and I do not believe that is bundled either. (It is also good practice to use M-mode following the procedure to make sure- and document definitively- that no pneumo occurred.)What about nerve blocks? Is US bundled?femoral, etc